Analysis of voice outcomes in pediatric patients following surgical procedures for laryngotracheal stenosis.

OBJECTIVE

To evaluate long-term (> 2 years) voice function and corresponding anatomical features in children who have undergone augmentation procedures for laryngotracheal stenosis.

DESIGN

Follow-up survey assessment.

SETTING

Academic pediatric referral center.

PATIENTS OR OTHER PARTICIPANTS

The families of 50 patients were contacted by mail, and completed home questionnaires. Of these 50 patients, 33 agreed to participate in a comprehensive hospital-based voice assessment, and 28 of these underwent fiberoptic endoscopy.

INTERVENTIONS

Hospital-based evaluation and parental questionnaire.

MAIN OUTCOME MEASURES

(1) Perceptual voice assessment from taped samples by using the Vocal Profile Analysis protocol performed by 3 speech and language therapists, (2) fiberoptic laryngeal endoscopy assessment performed by 3 otolaryngologists, and (3) parental assessment of voice by questionnaire. The conditions of the patients were categorized by etiology, the degree of stenosis, coexisting laryngeal lesions, and the type of surgical procedure that was done based on a review of medical records.

RESULTS

Eight of 33 patients were judged perceptually by using an amended version of the Vocal Profile Analysis scheme to have "normal" voices. In the remaining 25 patients, abnormalities were demonstrated in the parameters, including harshness (52%), whisper (36%), ventricular band phonation (21%), continuity (27%), mean pitch (27%), and falsetto voice (12%). By using endoscopy, 3 of 25 larynges were judged to be anatomically normal. Abnormalities that were found in the other patients included altered vocal fold mobility (42%), abnormal subglottis (38%), supraglottic vibration (31%), and anterior commissure blunting (31%). Supraglottic vibration corresponded with the perceptual judgment "ventricular band phonation type," and was seen in children with glottic insufficiency. Only 12% of parents indicated by questionnaire that deterioration of voice and dissatisfaction with voice function occurred after surgical procedures were performed.

CONCLUSIONS

A substantial proportion of children who have undergone laryngotracheal surgical procedures for stenosis demonstrate chronic voice and endoscopic abnormalities. The effects of these surgical procedures and preexisting laryngeal abnormalities on voice continue to be difficult to establish in the pediatric population. Careful management by speech and language therapists who are familiar with such children is essential for optimal voice function.